Cardiovascular Risk Factors After Adolescent Bariatric Surgery

Abstract

Background and objectives: Severely obese adolescents harbor numerous cardiovascular disease risk factors (CVD-RFs), which improve after metabolic and bariatric surgery (MBS). However, predictors of change in CVD-RFs among adolescents have not yet been reported.

Methods: The Teen-Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected anthropometric and health status data on 242 adolescents undergoing MBS at 5 centers. Predictors of change in CVD-RFs (blood pressure, lipids, glucose homeostasis, and inflammation) 3 years after Roux-en-Y gastric bypass and vertical sleeve gastrectomy were examined.

Results: The mean (±SD) age of participants at baseline was 17 ± 1.6 years; 76% were girls, and 72% were white, with a median BMI of 51. Participants underwent Roux-en-Y gastric bypass (n = 161), vertical sleeve gastrectomy (n = 67), or adjustable gastric banding (n = 14). Increasing weight loss was an independent predictor of normalization in dyslipidemia, elevated blood pressure (EBP), hyperinsulinemia, diabetes, and elevated high-sensitivity C-reactive protein. Older participants at time of surgery were less likely to resolve dyslipidemia compared with younger participants, whereas girls were more likely than boys to demonstrate improvements in EBP. Even those participants without frank dyslipidemia or EBP at baseline showed significant improvements in lipid and blood pressure values over time.

Conclusions: Numerous CVD-RFs improve among adolescents undergoing MBS. Increased weight loss, female sex, and younger age predict a higher probability of resolution of specific CVD-RFs. The elucidation of predictors of change in CVD-RFs may lead to refinements in patient selection and optimal timing of adolescent bariatric surgery designed to improve clinical outcomes.

FIGURE 1

A, Changes in the mean SBP (mm Hg) among participants with baseline EBP versus without baseline EBP. B, Changes in the mean DBP (mm Hg) among participants with baseline EBP versus without baseline EBP. Linear mixed modeling was used to evaluate associations of baseline presence of EBP with postoperative SBP and DBP values adjusted for age at surgery, sex, race, surgical procedure, clinical center, and BMI. * P < .05 versus previous time point.

FIGURE 2

A and B, Changes in median triglyceride levels among participants with elevated baseline triglyceride (>130 mg/dL) versus nonelevated baseline triglyceride (<130 mg/dL) levels. B, Changes in median HDL-C levels among participants with low baseline HDL-C (<40 mg/dL) versus nonreduced HDL-C (>40 mg/dL) levels. Linear mixed modeling was used to evaluate associations of baseline presence of abnormal triglyceride and HDL-C levels with corresponding values adjusted for age at surgery, sex, race, surgical procedure, clinical center, and BMI. * P < .05 versus previous time point.

FIGURE 3

Longitudinal changes in the total number of CVD-RFs (CVD-RF Total). CVD-RF Total represents a composite score of 4 equally weighted, independent CVD-RFs (EBP, dyslipidemia, diabetes, and abnormal hs-CRP).

FIGURE 4

Significant predictors of CVD-RF normalization 3 years after bariatric surgery. RRs and 95% CIs for CVD-RF normalization among subjects with abnormal risk factor levels at baseline are shown. Each model included age, sex, race, percent weight change from baseline, baseline BMI groups, CVD-RF total, surgical procedure, and clinical center as independent variables. Only RR relationships with significant P values (< .05) are displayed.